Caffeine Intoxication
DSM-III For more information, see Intoxication Diagnostic Criteria A'''. Recent consumption of caffeine, usually in excess of 250 mg. '''B. At least five of the following: # restlessness # nervousness # excitement # insomnia # flushed face # diuresis # gastrointestinal complaints # muscle twitching # rambling flow of thought and speech # cardiac arrhythmia # periods of inexhaustibility # psychomotor agitation C'''. Not due to any other mental disorder, such as an Anxiety Disorder. '''Differential Diagnosis Manic episodes, Panic Disorder or Generalized Anxiety Disorder can cause a clinical picture similar to that of Caffeine Intoxication. The temporal relationship of the symptoms to caffeine use establishes the diagnosis. DSM-IV For more information, see'' Substance Intoxication'' The essential feature of Caffeine Intoxication is recent consumption of caffeine and five or more symptoms that develop during, or shortly after, caffeine use (Criteria A and B). Symptoms that can appear following the ingestion of as little as 100 mg of caffeine per day include restlessness, nervousness, excitement, insomnia, flushed face, diuresis, and gastrointestinal complaints. Symptoms that generally appear at levels of more than 1 g/day include muscle twitching, rambling flow of thoughts and speech, tachycardia or cardiac arrhythmia, periods of inexhaustibility, and psychomotor agitation. Caffeine Intoxication may not occur despite high caffeine intake because of the development of tolerance. The symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion C). The symptoms must not be due to a general medical condition and are not better accounted for by another mental disorder (e.g., an Anxiety Disorder) (Criterion D). Diagnostic Criteria A'''. Recent consumption of caffeine, usually in excess of 250 mg (e.g., more than 2-3 cups of brewed coffee). '''B. Five (or more) of the following signs, developing during, or shortly after, caffeine use: # restlessness # nervousness # excitement # insomnia # flushed face # diuresis # gastrointestinal disturbance # muscle twitching # rambling flow of thought and speech # tachycardia or cardiac arrhythmia # periods of inexhaustibility # psychomotor agitation C'''. The symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. '''D. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder (e.g., an Anxiety Disorder). DSM-5 Diagnostic Criteria A'''. Recent consumption of caffeine (typically a high dose well in excess of 250 mg). '''B. Five (or more) of the following signs or symptoms developing during, or shortly after, caffeine use: # Restlessness. # Nervousness. # Excitement. # Insomnia. # Flushed face. # Diuresis. # Gastrointestinal disturbance. # Muscle twitching. # Rambling flow of thought and speech. # Tachycardia or cardiac arrhythmia. # Periods of inexhaustibility. # Psychomotor agitation. C'''. The signs or symptoms in Criterion B cause clinically significant distress or impairment in social, occupation, or other important areas of functioning. '''D. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance. Differential Diagnosis Other mental disorders Caffeine intoxication may be characterized by symptoms (e.g., panic attacks) that resemble primary mental disorders. To meet criteria for caffeine intoxication, the symptoms must not be associated with another medical condition or another mental disorder, such as an anxiety disorder, that could better explain them. Manic episodes; panic disorder; generalized anxiety disorder; amphetamine intoxication; sedative, hypnotic, or anxiolytic withdrawal or tobacco withdrawal; sleep disorders; and medication-induced side effects (e.g., akathisia) can cause a clinical picture that is similar to that of caffeine intoxication. Other caffeine-induced disorders The temporal relationships of the symptoms to increased caffeine use or to abstinence from caffeine helps to establish the diagnosis. Caffeine intoxication is differentiated from caffeine-induced anxiety disorder, with onset during intoxication and caffeine-induced sleep disorder, with onset during intoxication, by the fact that the symptoms in these latter disorders are in excess of those usually associated with caffeine intoxication and are severe enough to warrant independent clinical attention.